Brain metastasis from ocular malignant melanoma: a case report of a brain secondary lesion occurring 5 years after the primary lesion treatment

Ocular melanomas account for about 3.7% of all cases of melanoma and are the least common tumours of this organ. In the melanoma of the eye, distant metastases are common, and they occur in about half of the patients. The period from the occurrence of the primary to secondary change is 4–5 years [1]. Most often they are located in the liver, less often in lungs. Brain metastases from ocular malignant melanoma are very rare and usually observed with parallel occurrences of the liver [2]. In this paper we present a case of brain metastasis from choroidal melanoma, which occurred 5 years after the primary lesion treatment.
A 38-year-old patient was admitted to the Department of Neurosurgery, Neurotraumatology and Paediatric Neurosurgery in September 2014, November 2014 and January 2015 due to the diagnosis of a brain tumour in the magnetic resonance imaging (MRI) examination. The patient was initially treated for left eye choroidal melanoma. The first symptoms appeared in 2009, and surgical treatment was applied. In August 2014, the patient was diagnosed at the Department of Surgery because of abdominal pain. At that time tumours in the liver were diagnosed and the resection was performed. The result of the histopathological examination of resected lesions indicated melanoma. Then, the patient was transferred to the Regional Oncology Center for further treatment (CHTH). During the stay, the MRI of the head was performed, in which the tumour of the left parietal lobe was shown. The patient was transferred to the Department of Neurosurgery at the beginning of September 2014. At the time of admission, the patient was in a good general condition, with no neurological deficits. After analysing the entire clinical picture and the results of additional tests, the patient was qualified for surgical treatment.
A craniotomy of the left parietal region was performed. The dura was incised in a C-like shape. After retraction of the brain, the navy blue tumour masses was revealed and then removed macroscopically. The part attached to the sagittal sinus was coagulated. Material for histopathological examination was collected. The bone flap was restored. The course of the surgery and the postoperative period were without complications.
The initial histopathological diagnosis was oligodendroglioma anaplasticum, WHO III (Ki67 20%). After obtaining additional clinical data and re-evaluation, during which a strong immunohistochemical reaction for Melan-A was...


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